Isolation for C. difficile Colonization in Hospitalized Patients

Evidence Supporting Isolation of Colonized Patients

The World Society of Emergency Surgery guidelines recommend that C. difficile carriers should be placed in contact (enteric) precautions, as asymptomatic carriers contribute significantly to transmission and environmental contamination 1, 2
Asymptomatic carriers account for 29% of hospital-acquired CDI cases, demonstrating their substantial role as a reservoir for transmission 1, 2, 3
Environmental contamination occurs in 34% of rooms housing colonized patients, compared to 49% in rooms with active CDI patients—a clinically significant difference that still represents substantial contamination 1, 2, 3
Patients who are roommates or neighbors of CDI patients have a 3.94-fold increased risk of acquiring C. difficile, highlighting the importance of preventing transmission from all C. difficile-positive patients 1

The World Society of Emergency Surgery guidelines recommend placing colonized patients in a private room with en-suite hand washing and toilet facilities 1, 2
If private rooms are unavailable, cohort patients colonized with C. difficile in the same area, though recognize the theoretical risk of strain transfection 1
Maintain contact precautions until resolution of any diarrhea (passage of formed stool for at least 48 hours) 1

Hand hygiene with soap and water is mandatory—alcohol-based sanitizers do not kill C. difficile spores or remove them from hands 3, 4
Healthcare workers must use soap and water after glove removal when caring for colonized patients 3

Use sodium hypochlorite (bleach) solutions for environmental cleaning in areas housing colonized patients, as standard disinfectants may not eliminate spores 3
Daily to twice-daily disinfection of high-touch surfaces results in 45-85% reduction in CDI rates 3

Routine screening for asymptomatic carriers and eradication is not indicated because colonization is not believed to be a direct independent precursor requiring treatment 1, 2, 3

Screening for C. difficile colonization at admission combined with contact precautions reduced hospital-acquired CDI rates by 57% (from 6.9 to 3.0 per 10,000 patient-days; p<0.001) 1, 2, 3